Maybe your feet have always been flat. Or maybe you have started noticing something different: your shoes lean inward, your arches ache after a long day, your ankles feel tired, or the foot itself seems wider and flatter than it used to.
For a New Yorker, that change can become obvious quickly. A commute, a walk through Central Park, a day on hard floors, and an evening in dress shoes can add up to thousands of repetitive steps.
The important distinction is whether your flat foot is simply your lifelong foot type—or whether your arch is actively changing.
At Millennium Podiatry on Manhattan’s Upper East Side, we evaluate fallen arches by looking at the entire mechanical picture: the arch, heel alignment, tendons, gait, footwear, and the joints that are absorbing the consequences.
A low arch is not automatically a problem. A painful or progressively collapsing arch deserves an explanation.
“Fallen arches” is a common term for flattening of the arch of the foot. When standing, more of the sole may contact the ground and the heel may drift outward as the foot rolls inward.
Flat feet can be present from childhood or can develop later in life. Some people have flexible flat feet: the arch appears when the foot is not bearing weight and flattens when standing. Others have a rigid flat foot, where the arch remains low even when the foot is unloaded.
Neither shape automatically requires treatment. Many flexible flat feet are comfortable and function well. Treatment becomes more important when flattening is associated with pain, fatigue, progressive deformity, difficulty with activity, or changes in shoe fit.
If you have had low arches your entire life and they have never caused symptoms, the finding may simply reflect your natural anatomy.
But an arch that begins to flatten in adulthood—especially if one foot is changing more than the other—deserves closer attention. One important cause is dysfunction of the posterior tibial tendon, a major tendon that runs behind the inside of the ankle and helps support the arch.
As that tendon becomes inflamed, stretched, or degenerated, patients may notice pain and swelling along the inside of the ankle, increasing arch fatigue, a heel that appears to tip outward, and a foot that seems to collapse inward. In more advanced cases, pain can even develop on the outside of the ankle as the changed alignment places new stress on the joints.
If your arch is getting flatter now—not just “flat”—that change matters.
Patients with symptomatic flat feet may notice:
Because the foot is the foundation of the lower extremity, altered alignment can also change how forces travel through the ankle, knee, and leg. That does not mean every knee or back ache is caused by flat feet—but it is one reason we evaluate the entire gait rather than looking only at the arch.
There is no single cause. Common contributors include:
Some people inherit a naturally low or flexible arch and may never have symptoms. Others become symptomatic only after activity, footwear, or age changes the demands placed on the foot.
The posterior tibial tendon acts like an important support cable for the arch. When it weakens, adult-acquired flatfoot can progress over time.
An ankle or foot injury can alter alignment, damage supporting structures, or change the way weight is transferred through the foot.
Arthritis in the joints of the foot can contribute to stiffness, collapse, and a rigid flat-foot deformity.
Limited ankle motion can force the foot to compensate by rolling inward. A sudden increase in walking, running, or standing can expose a previously manageable biomechanical problem.
In some rigid flat feet, bones in the back of the foot are abnormally connected, limiting normal motion and contributing to a fixed flat-foot position. Related nerve irritation such as tarsal tunnel syndrome can also be evaluated when symptoms overlap.
Flat feet do not exist in a vacuum. They interact with the surfaces you walk on, the distance you cover, and the shoes you choose.
New York combines several things that can expose a vulnerable arch: hard pavement, long periods of standing, frequent walking, stairs, workouts, and rapid changes between sneakers, flats, loafers, boots, and heels.
A shoe can also reveal the problem. If the foot is widening or rolling inward, a pair that once felt elegant and effortless may suddenly pinch the forefoot, rub the bunion, or feel unstable at the heel.
The goal is not to build your life around your feet. It is to give your feet enough support to keep up with your life.
Exercises can be useful—but the answer depends on what is causing the flattening.
Calf stretching, heel raises, intrinsic-foot strengthening, balance work, and physical therapy can improve strength, flexibility, and control in selected patients. They can be particularly useful when weakness or limited motion is contributing to symptoms.
But exercises do not necessarily reverse a structural deformity, restore a degenerated tendon, or unlock a rigid flat foot. That is why an internet routine promising to “create an arch” is not a substitute for determining whether the foot is flexible, rigid, stable, or progressively collapsing.
A useful flat-foot evaluation should answer more than “Is the arch low?” We look at how the foot behaves under load.
The examination may include:
Weight-bearing X-rays may be used to quantify alignment and look for arthritis or structural changes. Ultrasound or MRI may be appropriate when the posterior tibial tendon itself needs closer evaluation.
Bring the sneakers you can walk in all day. Bring the loafers that make your arches ache. Bring the heels that suddenly feel unstable.
Wear patterns, heel counters, arch shape, toe-box width, and the way a shoe collapses can provide useful information about how your foot is functioning inside it.
For many Upper East Side patients, the solution is not choosing between fashion and function. It is understanding which mechanical demands a particular shoe places on the foot and designing a treatment plan around real life.
Treatment depends on whether the foot is flexible or rigid, how advanced the collapse is, what structures are painful, and whether the condition is stable or progressing.
A stable shoe with an appropriate heel counter and midsole can reduce excessive motion and make everyday walking more comfortable. The right shoe is the one that works with your foot and your activity—not simply the shoe marketed as “supportive.”
Custom orthotics can support a flexible flat foot, improve pressure distribution, and reduce excessive pronation. Unlike a generic insert, a prescription device can be designed around your specific arch, heel position, gait, and footwear needs.
Targeted therapy can address calf tightness, weakness, balance, and the muscles that help stabilize the foot and ankle.
When the posterior tibial tendon is inflamed or the arch is actively collapsing, a brace—or in some cases a period of protected weight-bearing—may be needed to unload the tendon before transitioning to longer-term support.
Plantar fasciitis, heel pain, bunions, ankle pain, and forefoot overload may all coexist with a flat foot. Treating only the most painful spot can miss the mechanical reason it developed.
Surgery is not the starting point for most flexible, symptomatic flat feet. When a rigid deformity, advanced tendon failure, arthritis, or progressive collapse does not respond to appropriate conservative care, reconstruction may be considered. Depending on the problem, this can involve tendon procedures, realignment of the heel or other bones, or fusion of arthritic joints.
An over-the-counter insert can be perfectly reasonable for mild, occasional fatigue. It adds cushioning and may provide enough general support for some feet.
But a painful or structurally changing flat foot is different. The question is no longer simply whether the shoe needs more padding—it is whether the foot needs more precise control, accommodation, or redistribution of force.
At Millennium Podiatry, custom orthotics are designed after evaluating the individual foot rather than selecting a generic arch shape. They can also be tailored for different types of footwear, which matters when the same patient moves between athletic shoes, work shoes, and dress shoes throughout the week.
Consider an evaluation if:
Progressive arch collapse is generally easier to manage when the cause is identified before the deformity becomes rigid or arthritic.
Your feet carry you through far more than a workout. They carry you through commutes, workdays, dinners, travel, sidewalks, stairs, and the shoes you choose for all of them.
A fallen arch does not automatically mean something is wrong. But when your foot is painful, changing, or no longer keeping up with your routine, it is worth understanding why.
At Millennium Podiatry on Park Avenue, Dr. Suzanne Levine, Dr. Jonathan Shalot, and the Millennium team evaluate the arch, tendon support, gait, and footwear so treatment can be tailored to the patient—not simply the footprint.
Schedule a fallen-arches evaluation at Millennium Podiatry on Manhattan’s Upper East Side and find out what your changing footprint may be telling you.
About the Author
Jonathan Shalot, DPM, FACFAS, DABPM
September 9, 2026
